Poorer Patients More Likely to Undergo Amputation?

Given that prior research has shown sex and racial disparities with regard to above knee amputation (AKA) after total knee arthroplasty (TKA), a team from Drexel University College of Medicine and the Rothman Orthopaedic Institute took on the task of furthering our understanding of such issues.

Their work, “Socioeconomic Status Is Associated with Risk of Above-knee Amputation After Periprosthetic Joint Infection of the Knee,” appears in the July 19, 2019 edition of Clinical Orthopaedics and Related Research.

The authors used data from the National Inpatient Sample (a database of inpatient hospitalizations) between 2010 and 2014. A total of 912 AKAs after periprosthetic joint infection were identified. They wrote, “Compared with patients with private insurance, patients with Medicare and Medicaid were at higher risk of AKA. There were no differences with regard to risk of AKA for white patients and black patients when compared with others.”

Co-author Alex Lieber, B.A. is an orthopedic resident at Drexel. He told OTW, “One of the key findings from our research was that patients living in lower income zip codes were more likely to undergo the devastating complication of an above knee amputation (AKA) after total knee arthroplasty ever after we had adjusted for differences in patient characteristics such as race, sex, and comorbidities. Patients from lower-income backgrounds are generally going to have worse access to medical care. This could lead to delayed and more-severe presentation of periprosthetic joint infection (PJI), perhaps resulting in a greater risk of AKA for treatment.”

“While patients who present with recurrent PJI present a challenging clinical scenario, it is important to remember that physicians may have inherent biases. Orthopedic surgeons should strive to treat every patient with full dedication and commitment, no matter what background or difficulties he or she brings.”